The URL can be used to link to this page

2010 well Permit 255 sherry r. t JAI CITY OF ATLANTIC BEACH f WELL PERMIT APPLICATION Date b ' ZO ' l � Owner's Name: � ga N ©li'V i c//Address: 2 u�� Jyt �r✓y �l1 U Well Address (if different than above): Well Location on Property(i.e. northeast corner, etc.) Well Installation Contractor: S-zo'e /-/�4 G-e X' Contractor License No.: 2 376 Phone: L i'rtro rFAX: 2 7 0 2 z J Contractor Address: le'-,7,7 ,� �t�,�� Rl w- Check Use of Well: Domestic Irrigation Other Estimated-Well Depth:_ Casing Depth: Z-42 Screen Interval from Zoto� Well Diameter: �y Casing Material__f� Is address currently connected to the City water system? Is address currently connected to the City sewer system?_ Has a Well Permit been obtained from the City of Jacksonville?/'/t) Permit Does the well require a permit from the St. Johns River Water Management District? (Not required for wells under 2-inches diameter installed by resident or wells under 6- inches diameter if installed by licensed well contractor). If permit is required,note Permit Number and attach a copy. NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PRE VENTER ON THE CITY WATER SERVICE. ON THE CUSTOMER'S SIDE OF THE METER. THE BACKFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT.